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8/17/2019 KTA Heni
1/3
REGISTER PELAYANAN KORBAN T
Puskesmas :
Kota : Provisi !
Bu"a : Ta#u !
NO
T a n g g a l K u n j u n g a n
R e k a m M
e d i k
N a m a L e n g k a p
A l a m a t L e n g k a p
K a s u s
U m u r
J e n i s K e l a m i n
P e n d i d i k a n
P e k e r j a a n
1 ! " # $ % & ' 1(
8/17/2019 KTA Heni
2/3
INDAK KEKERASAN TERHADAP PEREMPUAN, ANAK DAN KDRT
DI PUSKESMAS
Korban Terla
) t a t u s p e r k a * i n a n
T i n d a k K e k e r a s a n
T K P
+ a k t u K e j a d i a n
P e l a , a n a n , a n g d i b e r i k a n
- a m p a k
K e b a n g s a a n
U m u r
P e n d i d i k a n
P e k e r j a a n
11 1 1! 1" 1# 1$ 1% 1& 1' (
Pa,akumbu./
Kepala Puskesma
dr Ade Juseli
N0P 1'%"('( ((
8/17/2019 KTA Heni
3/3
por
K e t e r a n g a n
2 u b u n g a n - g K o r b a n
K e b a n g s a a n
1 !
(
s 0bu.
na
(" (1#